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General NPI Number Information
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NPI Number | 1386389443
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Entity Type | Organization
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Legal Business Name | CDT SERVICE CORPORATION
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 9381 E STOCKTON BLVD STE 102
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City | ELK GROVE
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State | CA
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Zip | 95624-5069
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Country | US
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Telephone | 916-914-6961
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Fax |
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Provider Business Mailing Address
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Address Line | 11230 GOLD EXPRESS DR # 310-353
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City | GOLD RIVER
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State | CA
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Zip | 95670-4484
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Country | US
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Telephone | 916-784-1149
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ROSS STUART MORTON
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Credential | JD
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Telephone | 916-784-1149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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